Effects of traditional Chinese exercises on sleep quality among post-stroke survivors: A systematic review and meta-analysis

Background Sleep disturbances are highly prevalent among post-stroke survivors, significantly hindering functional recovery and long-term quality of life. Traditional Chinese Exercises (TCEs), such as Tai Chi and Baduanjin, have emerged as promising non-pharmacological interventions; however, their integrated efficacy and impact on psychological comorbidities remain to be fully synthesized. Objective To systematically evaluate the effects of TCEs on sleep quality, anxiety, and depression in post-stroke survivors. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. We searched PubMed, Web of Science, Embase, OVID, CINAHL, and three Chinese databases (CNKI, WanFang, VIP) from inception to April 2026. RCTs evaluating the effects of TCEs (Tai Chi, Baduanjin, Liuzijue, etc.) on sleep-related outcomes in post-stroke survivors were included. Methodological quality was assessed using the Cochrane Risk of Bias tool (RoB 2.0), and the certainty of evidence was appraised via the GRADE framework. Meta-analyses and narrative syntheses were performed. Results Nine RCTs involving 690 randomized participants were included. Meta-analysis revealed that TCE interventions led to significantly greater improvements in sleep quality compared to control groups (MD = -2.15, 95% CI -2.65 to -1.65; P < 0.00001), with low heterogeneity (I 2 = 22%). Subgroup analysis revealed that TCEs significantly improved sleep quality against both active comparators and conventional care (active comparators: MD =-2.20, 95% CI: -2.81 to -1.58, P < 0.00001; conventional care: MD = -1.71, 95% CI: -3.03 to -0.40, P = 0.01). Furthermore, TCEs significantly reduced symptoms of anxiety (MD = -1.93; 95% CI: -2.82 to -1.05; P < 0.00001; I 2 = 0%) and depression (MD = -2. 2 1; 95% CI: -3.30 to -1.12; P < 0.00001; I 2 = 30%). The overall certainty of evidence was rated as moderate for sleep quality, and low for both anxiety and depression. Conclusions TCEs could be effective adjunct therapies for improving sleep quality and alleviating psychological distress in post-stroke rehabilitation. Nevertheless, future studies with rigorous methodological designs are needed to strengthen the evidence base.